NCLEX EXAM ga ga
Exam Solution ga
NCLEX RN Exam Preview 2026 A+ GRADE ASSURED CO ga ga ga ga ga ga ga ga
MPLETE SOLUTIONS AND VERIFIED ANSWERS (69A5D) ga ga ga ga ga
QUESTION 1 ga
1. "Use your hands and arms to support your body weight." Rationale: 1. Is true, but wat
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ch out if it isn't 2-3 finger-
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widths, because crutch paralysis can occur. S/S: Paresis & Paresthesias in wrist & hands.
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2. Is a fall risk. 3. Crutches should be 6 inches in front & 6 inches lateral. 4. Elbow shoul
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
d be bent at a 30 degree angle.
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ANSWER
The nurse is teaching a client how to ambulate using crutches. Which of the following information shou
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ld the nurse include? 1. "Use your hands and arms to support your body weight." 2. "Wear slippers whe
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
n ambulating with the crutches in your home." 3. "Maintain the crutches 12inch (30cm) in front of your
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feet while standing." 4. "Adjust the hand grips of the crutches so that your elbows are fully extended."
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QUESTION 2 ga
2. "Clients may develop stress ulcers and gastrointestinal bleeding." Rationale: Positive
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pressure ventilation increases the likelihood of developing stress ulcers and bleeding.
ga ga ga ga ga ga ga ga ga ga
ANSWER
The nurse has attended a staff education program about caring for clients who are receiving positive pr
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
essure mechanical ventilation. Which of the following statements by the nurse would indicate a correct
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understanding of the teaching? 1. "Clients should avoid range- ga ga ga ga ga ga ga ga
of motion (ROM) exercises until weaned from ventilation." 2. "Clients may develop stress ulcers and gas
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
trointestinal bleeding." 3. "Clients will be chemically paralyzed to improve oxygenation." 4. "Clients will
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experience diuresis and polyuria." ga ga ga
QUESTION 3 ga
3. 56-years-old, has hepatitis C (HCV) and has been afebrile for 24 hours.
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ANSWER
,The charge nurse must transfer a female client from the medical-
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surgical unit to the maternity unit to make a bed available. It would be most appropriate for the nurse
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to transfer the client who is 1. 28-years-old, had a right mastectomy and has a closed-
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wound drainage system. 2. 49-years- ga ga ga ga
old, has diabetes mellitus (type 2) and has begun receiving insulin. 3. 56-years-
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old, has hepatitis C (HCV) and has been afebrile for 24 hours. 4. 70-years-
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old, has a fractures left tibia and had an external fixation device applied 48 hours ago.
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QUESTION 4 ga
1. Heart failure who has a productive cough and is anxious. Rationale: The productive co
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ugh (Pink, frothy sputum) indicates pulmonary edema. The patient's anxiety may be cau
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sed by decreased perfusion.
ga ga ga
ANSWER
The nurse has been made aware of the following client situations. The nurse should first assess the clie
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nt with 1. Heart failure who has a productive cough and is anxious. 2. Regional enteritis (Crohn's Disea
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
se) who is reporting cramping abdominal pain and diarrhea. 3. Idiopathic thrombocytopenic purpura (I
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TP) who has petechiae on the trunk and is reporting heavy menses. 4. Chronic obstructive pulmonary d
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isease (COPD) who has dyspnea with exertion and is using accessory muscles to breathe.
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QUESTION 5 ga
1. Assisting a client with atrial fibrillation to shower. Rationale: A UAP can perform/assi
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st with hygiene. Only nurses can assess. Transporting a client in respiratory arrest is not
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safe to delegate to a UAP.
ga ga ga ga ga ga
ANSWER
The nurse and unlicensed assistive personnel (UAP) are caring for assigned clients. Which of the followi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ng tasks would be appropriate for the nurse to assign to UAP? 1. Assisting a client with atrial fibrillatio
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
n to shower. 2. Checking the ability of a client to swallow water after a transesophageal echocardiogra
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
m (TEE). 3. Observing while a client with dysphagia begins a thickened liquid diet. 4. Transporting a cli
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ent with respiratory distress to the radiology department for a chest radiograph.
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QUESTION 6 ga
3. 9-month-
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old client whose typical daily diet includes 10 bottles of 2% milk, 1 cup of apple juice, a
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nd 3 servings of infant cereal. Answer: Cow's milk should be introduced at 12 months ol
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d. It doesn't provide the necessary nutrients, and the baby can develop iron deficiency.
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ANSWER
The nurse has taken a nutritional history from parents of clients. It would be a priority for the nurse to
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follow up with the 1. 5-month-
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old client whose only source of nutrition is 5 formula feedings daily. 2. 7-month-
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old client who eats several crackers as finger food. 3. 9-month-
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, old client whose typical daily diet includes 10 bottles of 2% milk, 1 cup of apple juice, and 3 servings of
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
infant cereal. 4. 1-year-old client whose typical food intake includes 4 breast-
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feedings and 3 servings of cooked vegetables, pears, or sliced cheese.
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QUESTION 7 ga
2. Sharing the client's blood alcohol level (BAL) test result with the police officer who br
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ought the client to the emergency department (ED). Rationale: PHI is permitted to be dis
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cussed to police when PHI is needed to apprehend the perpetrator of a violent crime, su
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spect, or fugitive. ga ga
ANSWER
The nurse is planning a staff education program about client privacy. Which one of the following scenar
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ios should the nurse include as an example of a violation of client privacy? 1. Discussing with an unlice
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
nsed assistive personnel (UAP) that the UAP's assigned client will require a smaller condom catheter. 2.
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Sharing the client's blood alcohol level (BAL) test result with the police officer who brought the client t
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o the emergency department (ED). 3. Responding to the call light of the client who is assigned to anoth
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er nurse and needs assistance in the bathroom. 4. Allowing a nursing student who has been assigned to
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the client to review the client's medical record.
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QUESTION 8 ga
4. With heart failure who has a productive cough and is restless. Rationale: A productive
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cough (pink, frothy sputum) is indicative of pulmonary edema which is life threatening.
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Treatment would be to improve cardiac output by placing client in High-
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Fowler's, giving them O2, receiving mechanical ventilation, and medications.
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ANSWER
The nurse has become aware of the following client situations. The nurse should first assess the client:
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1. Who had a right pneumonectomy 24 hours ago and is in the High-
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Fowler's position while lying on the right side. 2. With chronic obstructive pulmonary disease (COPD)
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who is using pursed- ga ga ga
lip breathing and reporting hemoptysis. 3. Who had a wedge resection of the left lung 24 hours ago and
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is sitting in the High-
ga ga ga ga ga
Fowler's position. 4. With heart failure who has a productive cough and is restless.
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QUESTION 9 ga
2. The client is sleeping but is easily aroused.
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ANSWER
The nurse is caring for a 3-year-
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old client with a cerebral concussion who is being observed overnight in the pediatric unit. Which of th
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e following observations would be most significant for the nurse to report to the oncoming shift? 1. The
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client has a blood pressure of 94/58 mmHg and an apical pulse of 90. 2. The client is sleeping but is e
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
asily aroused. 3. The client's pupils are equal and reactive to light. 4. The client has an axillary tempera
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Exam Solution ga
NCLEX RN Exam Preview 2026 A+ GRADE ASSURED CO ga ga ga ga ga ga ga ga
MPLETE SOLUTIONS AND VERIFIED ANSWERS (69A5D) ga ga ga ga ga
QUESTION 1 ga
1. "Use your hands and arms to support your body weight." Rationale: 1. Is true, but wat
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ch out if it isn't 2-3 finger-
ga ga ga ga ga ga
widths, because crutch paralysis can occur. S/S: Paresis & Paresthesias in wrist & hands.
ga ga ga ga ga ga ga ga ga ga ga ga ga g
2. Is a fall risk. 3. Crutches should be 6 inches in front & 6 inches lateral. 4. Elbow shoul
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
d be bent at a 30 degree angle.
ga ga ga ga ga ga ga
ANSWER
The nurse is teaching a client how to ambulate using crutches. Which of the following information shou
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ld the nurse include? 1. "Use your hands and arms to support your body weight." 2. "Wear slippers whe
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
n ambulating with the crutches in your home." 3. "Maintain the crutches 12inch (30cm) in front of your
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
feet while standing." 4. "Adjust the hand grips of the crutches so that your elbows are fully extended."
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 2 ga
2. "Clients may develop stress ulcers and gastrointestinal bleeding." Rationale: Positive
ga ga ga ga ga ga ga ga ga ga ga
pressure ventilation increases the likelihood of developing stress ulcers and bleeding.
ga ga ga ga ga ga ga ga ga ga
ANSWER
The nurse has attended a staff education program about caring for clients who are receiving positive pr
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
essure mechanical ventilation. Which of the following statements by the nurse would indicate a correct
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
understanding of the teaching? 1. "Clients should avoid range- ga ga ga ga ga ga ga ga
of motion (ROM) exercises until weaned from ventilation." 2. "Clients may develop stress ulcers and gas
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
trointestinal bleeding." 3. "Clients will be chemically paralyzed to improve oxygenation." 4. "Clients will
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
experience diuresis and polyuria." ga ga ga
QUESTION 3 ga
3. 56-years-old, has hepatitis C (HCV) and has been afebrile for 24 hours.
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
,The charge nurse must transfer a female client from the medical-
ga ga ga ga ga ga ga ga ga ga
surgical unit to the maternity unit to make a bed available. It would be most appropriate for the nurse
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
to transfer the client who is 1. 28-years-old, had a right mastectomy and has a closed-
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
wound drainage system. 2. 49-years- ga ga ga ga
old, has diabetes mellitus (type 2) and has begun receiving insulin. 3. 56-years-
ga ga ga ga ga ga ga ga ga ga ga ga
old, has hepatitis C (HCV) and has been afebrile for 24 hours. 4. 70-years-
ga ga ga ga ga ga ga ga ga ga ga ga ga
old, has a fractures left tibia and had an external fixation device applied 48 hours ago.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 4 ga
1. Heart failure who has a productive cough and is anxious. Rationale: The productive co
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ugh (Pink, frothy sputum) indicates pulmonary edema. The patient's anxiety may be cau
ga ga ga ga ga ga ga ga ga ga ga ga
sed by decreased perfusion.
ga ga ga
ANSWER
The nurse has been made aware of the following client situations. The nurse should first assess the clie
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
nt with 1. Heart failure who has a productive cough and is anxious. 2. Regional enteritis (Crohn's Disea
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
se) who is reporting cramping abdominal pain and diarrhea. 3. Idiopathic thrombocytopenic purpura (I
ga ga ga ga ga ga ga ga ga ga ga ga ga
TP) who has petechiae on the trunk and is reporting heavy menses. 4. Chronic obstructive pulmonary d
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
isease (COPD) who has dyspnea with exertion and is using accessory muscles to breathe.
ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 5 ga
1. Assisting a client with atrial fibrillation to shower. Rationale: A UAP can perform/assi
ga ga ga ga ga ga ga ga ga ga ga ga ga
st with hygiene. Only nurses can assess. Transporting a client in respiratory arrest is not
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
safe to delegate to a UAP.
ga ga ga ga ga ga
ANSWER
The nurse and unlicensed assistive personnel (UAP) are caring for assigned clients. Which of the followi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ng tasks would be appropriate for the nurse to assign to UAP? 1. Assisting a client with atrial fibrillatio
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
n to shower. 2. Checking the ability of a client to swallow water after a transesophageal echocardiogra
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
m (TEE). 3. Observing while a client with dysphagia begins a thickened liquid diet. 4. Transporting a cli
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ent with respiratory distress to the radiology department for a chest radiograph.
ga ga ga ga ga ga ga ga ga ga ga
QUESTION 6 ga
3. 9-month-
ga
old client whose typical daily diet includes 10 bottles of 2% milk, 1 cup of apple juice, a
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
nd 3 servings of infant cereal. Answer: Cow's milk should be introduced at 12 months ol
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
d. It doesn't provide the necessary nutrients, and the baby can develop iron deficiency.
ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
The nurse has taken a nutritional history from parents of clients. It would be a priority for the nurse to
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
follow up with the 1. 5-month-
a ga ga ga ga ga
old client whose only source of nutrition is 5 formula feedings daily. 2. 7-month-
ga ga ga ga ga ga ga ga ga ga ga ga ga
old client who eats several crackers as finger food. 3. 9-month-
ga ga ga ga ga ga ga ga ga ga
, old client whose typical daily diet includes 10 bottles of 2% milk, 1 cup of apple juice, and 3 servings of
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
infant cereal. 4. 1-year-old client whose typical food intake includes 4 breast-
ga ga ga ga ga ga ga ga ga ga ga ga
feedings and 3 servings of cooked vegetables, pears, or sliced cheese.
ga ga ga ga ga ga ga ga ga ga
QUESTION 7 ga
2. Sharing the client's blood alcohol level (BAL) test result with the police officer who br
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ought the client to the emergency department (ED). Rationale: PHI is permitted to be dis
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
cussed to police when PHI is needed to apprehend the perpetrator of a violent crime, su
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
spect, or fugitive. ga ga
ANSWER
The nurse is planning a staff education program about client privacy. Which one of the following scenar
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ios should the nurse include as an example of a violation of client privacy? 1. Discussing with an unlice
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
nsed assistive personnel (UAP) that the UAP's assigned client will require a smaller condom catheter. 2.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
Sharing the client's blood alcohol level (BAL) test result with the police officer who brought the client t
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
o the emergency department (ED). 3. Responding to the call light of the client who is assigned to anoth
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
er nurse and needs assistance in the bathroom. 4. Allowing a nursing student who has been assigned to
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the client to review the client's medical record.
ga ga ga ga ga ga ga ga
QUESTION 8 ga
4. With heart failure who has a productive cough and is restless. Rationale: A productive
ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
cough (pink, frothy sputum) is indicative of pulmonary edema which is life threatening.
a ga ga ga ga ga ga ga ga ga ga ga ga ga
Treatment would be to improve cardiac output by placing client in High-
ga ga ga ga ga ga ga ga ga ga ga
Fowler's, giving them O2, receiving mechanical ventilation, and medications.
ga ga ga ga ga ga ga ga
ANSWER
The nurse has become aware of the following client situations. The nurse should first assess the client:
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
1. Who had a right pneumonectomy 24 hours ago and is in the High-
ga ga ga ga ga ga ga ga ga ga ga ga ga
Fowler's position while lying on the right side. 2. With chronic obstructive pulmonary disease (COPD)
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
who is using pursed- ga ga ga
lip breathing and reporting hemoptysis. 3. Who had a wedge resection of the left lung 24 hours ago and
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
is sitting in the High-
ga ga ga ga ga
Fowler's position. 4. With heart failure who has a productive cough and is restless.
ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 9 ga
2. The client is sleeping but is easily aroused.
ga ga ga ga ga ga ga ga
ANSWER
The nurse is caring for a 3-year-
ga ga ga ga ga ga
old client with a cerebral concussion who is being observed overnight in the pediatric unit. Which of th
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e following observations would be most significant for the nurse to report to the oncoming shift? 1. The
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
client has a blood pressure of 94/58 mmHg and an apical pulse of 90. 2. The client is sleeping but is e
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
asily aroused. 3. The client's pupils are equal and reactive to light. 4. The client has an axillary tempera
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
